Two of the most commonly used tools for assessing the patient’s level of consciousness is the ACVPU scale and the Glasgow Coma Scale (GCS).
ACVPU is an acronym for “Alert, Confusion, Verbal, Pain, and Unresponsive”. ACVPU is actually AVPU and sometimes this is still the used abbreviation in some literature but this has been updated to include the confusion component to assess and differentiate those who are awake and coherent to those who are alert but with some acute alteration in mentation.
Both ACVPU and GCS are tools used to assess neurologic impairment. It provides clinicians an information of the patient’s level of consciousness.
ACVPU
ACVPU is used for immediate assessments and the acronyms make it convenient and easy to remember. It is integrated in the National Early Warning Score 2 (NEWS 2) charts. This chart is used to record observations or vital signs with scoring systems for track and trigger.
In using ACVPU, it is important to consider the full context of the assessment to avoid misinterpretations since a patient who is sleeping may be presumed as unconscious (Peate, 2019). The overall clinical picture must be looked into so that ACVPU can be used correctly.
The ACVPU Scale
The use of the ACVPU Scale
video from Health Education England - HEE, 2020
Useful resource links for ACVPU:
· Using the AVPU scale:
· ACVPU Scale in NEWS and the confused patient:
Glasgow Coma Scale (GCS)
The Glasgow Coma Scale is a 15 point scale used to assess the level of consciousness. It is a common tool utilised for patients with neurologic deterioration such as in the case of stroke, head injury or trauma. The scale is composed of three components: Eye Opening Response, Verbal Response, and Motor Response. The highest score is 15 and the lowest score is 3. If a component cannot be assessed (e.g. assessing verbal response in a laryngectomy patient), then it will be written as “NT” for that area which means “Not Testable”. GCS was developed in 1974. 40 years later in 2014, the terminologies used for the response has been updated (Teasdale, 2014).
Glasgow Coma Scale
Using the Glasgow Coma Scale
video from GCS at 40 (2014)
Useful resource links for Glasgow Coma Scale:
· Glasgow Coma Scale website: https://www.glasgowcomascale.org/
· GLASGOW COMA SCALE : Do it this way (downloadable pdf): https://www.glasgowcomascale.org/downloads/GCS-Assessment-Aid-English.pdf?v=3
ACVPU and GCS are just some of the commonly used tools for assessing the level of consciousness. In practice, they are just part of an overall assessment since other areas will also be checked such as pupil size and reaction, deep reflexes and etc., which are also covered in neurological examination. The key thing is that one must be adequately trained when using these tools for safe and effective practice. A clinician must be supervised with competencies signed off first before performing the procedure on their own. Most importantly, institutional policies should also be followed and taken into consideration.
Suggested readings:
· Waterhouse, C. (2017) Practical aspects of performing Glasgow Coma Scale observations, Nursing Standard, 31 (35), pp. 40–46. DOI:10.7748/ns.2017.e10189. Available at: https://journals.rcni.com/nursing-standard/practical-aspects-of-performing-glasgow-coma-scale-observations-ns.2017.e10189
· Teasdale G (2014) Forty years on: updating the Glasgow Coma Scale. Nursing Times; 110: 42, 12-16. Available at: https://www.nursingtimes.net/clinical-archive/accident-and-emergency/forty-years-on-updating-the-glasgow-coma-scale-10-10-2014/
· Mehta, R. and Chinthapalli, K. (2019) Glasgow coma scale explained, BMJ, pp. l1296. DOI: https://doi.org/10.1136/bmj.l1296
Disclaimer:
The content in this blog is for informational purposes only and should not be taken as medical advice. It is always best to consult your doctor for medical questions that you might have.
If you are a healthcare provider, the content here should not be used to make any diagnosis, give advice or prescribe treatment as this blog is for informational and educational purposes only. Healthcare is an everchanging field and each patient is unique. It is your responsibility as a healthcare provider to always refer to current care standards and practices.
References:
GCS at 40, 2014. Glasgow Coma Scale At 40 | The New Approach To Glasgow Coma Scale Assessment. [video] Available at: <https://www.youtube.com/watch?v=v6qpEQxJQO4> [Accessed 27 January 2021].
Health Education England - HEE, 2020. 9 Measuring The Level Of Alertness. [video] Available at: <https://www.youtube.com/watch?v=mo1DCAJddkQ> [Accessed 27 January 2021].
Mehta, R. and Chinthapalli, K. (2019) Glasgow coma scale explained, BMJ, pp. l1296. DOI: https://doi.org/10.1136/bmj.l1296
Peate, I. (2019) Learning to Care: The Nursing Associate, Elselvier:London
Teasdale G (2014) Forty years on: updating the Glasgow Coma Scale. Nursing Times; 110: 42, 12-16.
Waterhouse, C. (2017) Practical aspects of performing Glasgow Coma Scale observations, Nursing Standard, 31 (35), pp. 40–46. DOI:10.7748/ns.2017.e10189.
Williams, B. (2019) The National Early Warning Score and the acutely confused patient, Clinical Medicine, 19 (2), pp. 190–191. DOI:10.7861/clinmedicine.19-2-190.
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